When people suffer work-related injuries, they are generally eligible for workers’ compensation benefits. Medical costs related to a work injury, disease or illness contracted while working, or a health condition that was caused by the work a person performed should be fully covered. However, there are a variety of requirements that must be met during treatment, and some limitations may apply. Injured workers will want to make sure to understand their rights and the procedures that will be followed as they receive treatment, and they may need to work with an attorney to make sure they receive the medical benefits they deserve.

Medical Care Covered by Workers’ Compensation

When doctors or other medical professionals provide treatment covered by workers’ comp, this treatment must be evidence-based. It must be scientifically proven to be an effective treatment for the injuries that a person experienced while working or due to their work. The California Department of Workers’ Compensation (DWC) maintains a set of regulations known as a medical treatment utilization schedule (MTUS). This schedule provides guidelines for appropriate treatments for different parts of the body, including those related to post-surgery pain treatment and therapy, as well as acupuncture.

A DWC claims administrator must authorize all forms of medical treatment, and they will perform a utilization review (UR) to ensure that a planned course of treatment is medically necessary. The UR will determine whether treatment recommended by a doctor falls within the guidelines of the MTUS. If the recommended treatment is not included in the MTUS or goes beyond the guidelines, the doctor must provide evidence to the claims administrator showing why this treatment will be necessary and demonstrating its effectiveness. 

There are multiple types of injuries that a person may suffer in the workplace or because of the work they have performed. Back injuries can be very painful, and they can limit a person’s movements and their ability to bend over and lift objects, affecting the work they can perform. Because of this, workers who suffer back injuries will want to determine whether they can receive workers’ compensation.

Common Types of Back Injuries

An injury may affect a person’s backbone and spinal cord, or they may experience injuries to the muscles and ligaments in the back. These injuries may include:

• Strains and sprains - Back muscles and ligaments may be injured because a person attempted to lift an object that was too heavy, because they twisted their back into an unnatural position, or due to ongoing strain to the back muscles. In many cases, these injuries require a person to rest and refrain from strenuous activities for several days. A person may also need to take anti-inflammatory medications.

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People who suffer work-related injuries are eligible for workers’ compensation benefits. These benefits cover the costs of medical care, and if an injured worker is required to miss work or suffers a loss of income, they may also receive disability benefits. While temporary disability benefits will apply in situations where a person cannot work or can only work at a reduced capacity for a short period of time, permanent disability benefits may be available for those who have suffered permanent impairments to their ability to earn an income. However, the process of determining the amount an injured worker can receive in permanent disability benefits can be complicated, and it involves the calculation of a PD rating.

How Is a PD Rating Determined?

Before a person can qualify for permanent disability (PD) benefits, a doctor will need to determine that they have reached the point in their treatment where their medical condition is permanent and stationary (P&S). This is also known as maximum medical improvement (MMI). At this point, the doctor will send a report to the Department of Workers’ Compensation (DWC) that specifies the person’s level of impairment using an “impairment number” while also noting whether there were any non-work-related factors that contributed to the impairment.

The DWC’s Disability Evaluation Unit (DEU) will review the doctor’s report and use the impairment number to calculate the person’s percentage of disability. This will indicate the amount of loss of their bodily or mental functions that would affect their ability to return to working in the position they held before being injured. This percentage may then be reduced based on the amount of the disability that was the result of any issues unrelated to the work a person performed. The resulting amount is known as the PD rating, which will be used to determine the total amount of benefits the person will receive for their permanent disability.

In California, employees who are injured on the job are entitled to reimbursement for medical expenses and part of their lost income through workers’ compensation. With some exceptions, anyone who is hurt while performing work tasks is eligible for workers’ compensation or “workers’ comp.” However, some workers’ compensation claims are denied. If you or a loved one applied for workers’ compensation and were denied, a workers’ compensation lawyer may be able to help.

When is a Worker Not Entitled to Workers Compensation?

California workers’ compensation is extensive and covers most individuals. However, there are some exceptions to this generality. For example, if you work in exchange for housing or other aid instead of wages, you do not qualify for workers’ compensation. Individuals who are employed by their parent, spouse, or child in a family business may also be excluded from workers’ compensation. You do not qualify for workers’ compensation if the injury was not related to your job or it occurred when you were off the clock.  

Only workers who are classified as employees are entitled to workers’ compensation. So, if you are an independent contractor, you may not receive reimbursement for your medical expenses or lost income. That being said, many workers who are classified as independent contractors should be classified as employees. A workers’ compensation attorney can help you determine if you have been misclassified.

Most people struggle with one or more medical conditions at some point in their lives. Whether you have an old sports injury, a degenerative disease, or hearing or vision problems, managing the condition’s symptoms may be a constant struggle. So what happens when work tasks aggravate an existing medical concern? Is the injured worker entitled to financial compensation through workers’ compensation? Is the worker barred from financial recovery because he or she had the condition before being hired?

California Workers’ Compensation Typically Covers Aggravation of Pre-Existing Conditions

Many people assume that they cannot get workers’ compensation for a medical issue that existed before starting their job. Fortunately, California workers’ compensation does cover situations in which a person’s job worsens a pre-existing medical problem. Unfortunately, it is often difficult to get the compensation you need for a pre-existing condition. To get reimbursement for medical bills and lost wages through your employer’s workers’ compensation insurer, you must prove that:

• Your medical condition was aggravated or worsened by your job duties

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Workers’ compensation is typically associated with traumatic workplace incidents such as falls or equipment-related accidents. However, California workers’ compensation may also cover illnesses and diseases that a person acquires at work. If you have fallen ill and the condition is work-related, you may be entitled to compensation for medical bills and part of your lost income. Unfortunately, workers’ compensation claims involving illnesses are often harder to prove than other types of worker’s compensation claims.  

What Types of Illnesses May Be Covered by Workers’ Compensation?

California covers injuries and illnesses resulting from the work environment and/or completing work tasks. So, if your illness or disease can be linked to job duties or the workplace, you may qualify for compensation. Some illnesses that often lead to workers’ compensation claims include:

• COVID-19 – If you contracted COVID-19 at work, it is possible that your medical bills and lost income will be recoverable through a workers’ compensation claim. Respiratory illnesses like coronavirus were already typically covered by California workers’ compensation. However, Senate Bill 1159 and other legislation have further established workers’ right to compensation.

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Our brains control everything from walking to problem-solving. When the brain is damaged in a work accident, the worker may be left with severe symptoms that significantly impact his or her life. Fortunately, most injured workers are entitled to compensation through their employer’s workers’ compensation insurance. Unfortunately, obtaining workers’ compensation is sometimes a difficult process. In situations like these, a workers’ compensation lawyer can be an extremely useful asset.

Symptoms of a Brain Injury Can Be Subtle at First

A traumatic brain injury (TBI) occurs when the brain is directly damaged by an object penetrating the skull or, more commonly, when a force causes the brain to strike the inside of the skull. Falling, being struck by objects, and equipment-related accidents are some of the most common on-the-job causes of TBI. One factor that can make TBI especially dangerous is that many TBI sufferers do not immediately realize how badly they are injured. Some symptoms are delayed by hours, days, or longer. Symptoms of TBI often include:

• Headache
• Dizziness
• Blurred vision
• Vomiting
• Ringing in the ears
• Slurred speech
• Disorientation
• Cognitive and behavioral changes
• Sleeping problems
• Mood swings or depression

TBI Can Lead to Profound Financial Losses

A traumatic brain injury can become a major financial burden. Usually, doctors use a CT scan or MRI to diagnose a brain injury and look for brain bleeds. The sufferer may need to remain in the hospital for several days while he or she recovers. A TBI patient may also need ongoing medical care after leaving the hospital. These medical treatments quickly add up. Fortunately, workers’ compensation may cover medical bills as well as a portion of your lost income after a TBI.

Fortunately, employees who are hurt on the job in California typically have access to reimbursement through workers’ compensation. While the law entitles most injured workers to compensation for medical expenses and a portion of their lost income, successfully obtaining this compensation is not always easy. There are specific steps an injured worker must take to get compensation after a work injury. Additionally, some mistakes can derail the process of obtaining compensation.

Mistakes That Can Impair Your Ability to Get Workers’ Compensation After a Work Injury

Work injuries can occur during a sudden accident such as falling, or slowly over time due to repetitive motions like bending or twisting. Whatever the cause, a work injury can damage your ability to earn a living. These injuries may also lead to steep medical expenses. Ideally, getting the compensation you need for these financial losses would be straightforward. Unfortunately, obtaining workers’ compensation is sometimes quite challenging. To give yourself the best chances of getting adequate compensation after a work injury, avoid these mistakes:

• Incorrectly reporting the injury – If you are hurt at work, tell your supervisor immediately. Fill out the appropriate incident forms or other paperwork. If you wait too long to report the injury or do not have a paper trail to show that you reported the injury, it can be hard to prove the timeline of the injury.
• Not following the doctor’s orders – For many people, going to the doctor is something that they avoid at all costs. However, not getting proper medical care after a work injury can significantly damage your ability to get compensation. The insurance company may claim that neglecting to get appropriate medical care proves that your work injury is not as severe as you claim.
• Accepting an inadequate settlement – Save for very specific exceptions, injured workers have a right to workers’ compensation per California law. Do not accept an unreasonably low payment. Speak with a workers’ compensation lawyer for help if you feel that you are being offered an inadequate workers’ compensation settlement. Your lawyer can help you negotiate the settlement or file an appeal if your workers’ compensation claim is denied.

Contact a Hollister Workers’ Compensation Lawyer

At Cramer & Martinez, LLP, we understand the obstacles that many workers run into when trying to get workers’ compensation. Our team of skilled San Benito County workers’ compensation attorneys can help you with filing a claim, negotiating a settlement, appealing a denied claim, and much more. Call us at 408-848-1113 for a confidential consultation today.

Being a firefighter is one of the most dangerous jobs a person can have. However, traumatic injuries like burns or broken bones are not the only type of medical concern that may afflict a firefighter. Firefighters are also exposed to toxic fumes and carcinogenic substances in the course of their work that can cause cancer. If you are a firefighter who has been diagnosed with cancer, you may be entitled to financial compensation through workers’ compensation.

How Do I Prove My Cancer is a Work-Related Illness?

Workers’ compensation only covers injuries and illnesses that were acquired during the course of employment. Illnesses like cancer can take months, years, or even decades to show up on medical tests. You may wonder how you can prove that your cancer is a work-related illness. Fortunately, firefighters, peace officers, and the Department of Forestry workers are specifically addressed by California workers’ compensation laws.

Per the William Dallas Jones Cancer Presumption Act of 2010, cancer suffered by firefighters and other designated workers is presumed to be work-related. Unless sufficient evidence to the contrary can be shown, cancer is automatically considered a work-related illness for the purposes of workers’ compensation claims. This presumption extends to former firefighters for a period of three months per year of service for a maximum of ten years.

Ideally, workplace accidents would never happen. Unfortunately, even the safest workplaces experience employee injuries. If you were hurt in a workplace accident, you may have questions about your ability to get reimbursement for medical bills and lost income through workers’ compensation. You may wonder, “Can I get compensation if I caused my injury?” Typically, workers’ compensation coverage is “no-fault” meaning that an employee is covered even if he or she was at fault for the accident or injury. However, there are exceptions to this rule.

Criteria for Workers’ Compensation Coverage in California

To know if you can get financial reimbursement through workers’ compensation, you must first determine if you qualify for workers’ compensation coverage. Employers with one or more employees are required to have workers’ compensation insurance per California law. Full-time, part-time, and seasonal employees are covered by workers’ compensation. If you are an independent contractor, you most likely do not qualify for reimbursement through workers’ compensation.

Circumstances of the Injury

Another factor that determines whether you get compensation through workers’ comp is the circumstances of the injury. Normally, fault does not influence an employee’s eligibility for workers’ compensation. If your own mistake caused the accident or injury, you are most likely still covered. However, the injury must have taken place while you were performing work duties.

When most people think of workers’ compensation claims, they picture a worker suffering from a broken leg or a back injury. While physical injuries do make up the majority of workers’ compensation claims in California, many workers also suffer from psychiatric injuries caused by traumatizing work incidents. Firefighters, police officers, and other first responders are at an especially high risk of psychological injuries. These workers are often witness to extremely upsetting situations involving gruesome injuries, death, and other tragedies. However, psychological injuries can occur to workers in any profession.

California Workers’ Compensation Law Regarding Emotional or Psychological Harm

Employers in California are required to carry workers’ compensation insurance. Employees who suffer an on-the-job injury are typically entitled to compensation for medical bills and a portion of their lost income. California workers’ compensation covers physical injuries as well as certain work-related emotional and psychological injuries.

California law requires employers to carry workers’ compensation insurance. This insurance is designed to cover medical bills and partial lost wages for workers who are hurt on the job. California law also prohibits employers from retaliating against employees who have filed a workers’ compensation claim. Employers cannot fire or otherwise discriminate against a worker simply because he or she filed for workers’ compensation. Victims of workers’ compensation discrimination may be entitled to job reinstatement, additional financial compensation, and reimbursement for lost wages.

What Actions Are Considered Discriminatory?

Some employers are irritated by an employee filing a workers’ compensation claim – even when the employee has a legitimate work injury and is rightfully entitled to workers’ compensation benefits. The employer may take out this frustration on the employee by treating him or her differently than the other employees. Not only is this practice unethical, it is also unlawful. Employers who discriminate against an employee because of a workers’ compensation claim, settlement, or award are guilty of a misdemeanor criminal offense.

Examples of actions that may constitute workers’ compensation discrimination or retaliation include:

While some professions are more dangerous than others, a workplace injury can happen to anyone. Some work injuries are the result of a one-time incident such as a slip and fall or equipment-related accident. Other injuries are caused by months or years of repetitive stress on certain body parts. Whatever the cause, work-related accidents can incur a significant financial burden on injured workers and their families. Workers’ compensation is intended to relieve this financial burden, however, workers’ compensation is not available to all workers. Supporters of Senate Bill 216 say that the legislation is one step toward making workers’ compensation available to a greater number of California workers.

Supporters of SB-216 Say That Many Contractors Lie About Having Employees

California law requires employers to carry workers’ compensation insurance. However, contractors who do not have employees are exempt from this requirement. Of the nearly quarter-million contractors in California, over half report no employees. However, some believe that many of these contractors are lying. The author of SB-216, California State Senator Bill Dodd, has stated that contractors who falsely claim exemption increase the cost of workers’ compensation for others. This gives the contractors an unwarranted financial advantage over other contractors. Moreover, these falsifications leave injured workers without the protection they deserve. The costs associated with ambulance transportation, hospitalization, and ongoing medical needs resulting from a work injury can quickly add up to staggering amounts. When combined with lost wages from missed work, a serious work injury can nearly bankrupt an injured worker.

Legislation Aims to Provide Immediate Coverage to Workers in Construction, HVAC, and Related Fields

The proposed legislation would immediately require contractors in the heating, air conditioning, concrete, and tree service industries to obtain workers’ compensation insurance. The rest of the licensed contractors in California would need to get coverage by 2025. This would ensure that workers who are hurt on the job have access to the financial compensation they need. Contractors who violate the proposed legislation would be subject to license suspension and even misdemeanor criminal charges.

It is hard to believe, but spring is just around the corner in Santa Clara. While many welcome the warmer weather, it is important to consider the effect that the heat can have on workers. Heatstroke, heat exhaustion, heat syncope, and heat cramps can affect both outdoor workers and indoor workers in high-risk occupations. According to the Centers for Disease Control and Prevention (CDC), approximately 700 heat-related deaths occur in the United States each year. Heat illness also leads to thousands of non-fatal injuries including injuries sustained because of fainting. Those who are hurt may be able to recover damages through a workers compensation or personal injury claim depending on the details of their case.

OSHA Guidelines for Safe Work Environments

California is known for its warm, sunny weather. Unfortunately, working in hot environments can lead to serious and even fatal injuries. The Occupational Safety & Health Administration (OSHA) states that 50 – 70 percent of heat-related fatalities occur during the initial days of working in warm conditions when the body has not yet acclimatized to the hot environment. OSHA has established guidelines for employers with workers in outdoor or indoor environments that involve hot environments, heavy physical activity, or heavy clothing. Workers in certain industries are often at particularly high risk of heat-related illnesses and injuries, including those who work in:

This year has been unprecedented, to say the least, especially when it comes to safety in the workplace. As COVID-19 hit the United States, most businesses went fully remote, and almost one year later, many are still working from home. Those considered essential workers, however, were not given this option. Essential workers have been placed at a much higher risk of contracting COVID-19 than those who have been granted the benefit of keeping their job while also working remotely. The state of California recognized this and granted additional protective measures to those on the frontlines. With the vaccine now being administered, many workplaces are requiring their employees to get the vaccine before returning to work. Getting the vaccine may protect against COVID-19, but it has also left many with serious side effects and wondering if workers’ compensation is an option.

Senate Bill 1159

California legislature released Senate Bill 1159 back in September 2020, which states that COVID-19 may be considered a work-related illness, making employees eligible for workers’ comp, if the following conditions are met:

Those who are injured at their workplace have certain rights outlined by the state of California, regardless of the nature of their position. There are a number of misconceptions about California’s workers’ compensation policy, including the assumption that this financial assistance is solely reserved for those in especially dangerous fields such as construction. It is important to have an understanding of your rights as you join the California workforce since a single injury can leave you in physical and financial disarray. 

1. What Should I Do If I Have a Work Injury?

After any type of injury, it is common to “wait it out” to see if reporting the injury or seeking medical treatment is truly necessary. Perhaps you slipped on wet floors or have a gash on your arm from improperly stowed tools and believe that your injuries are fairly minor. Regardless of the nature of your injury, you should immediately report the injury to your employer and seek medical treatment. This report will ensure that the nature of your injuries is recorded from the onset and prevent you from problems and delays in receiving benefits.

Construction sites are some of the most dangerous work environments that exist. Workers must often work with hazardous materials, atop scaffolds and rooftops, and among heavy machinery and dangerous equipment. It is for these reasons that construction workers suffer catastrophic injuries and fatalities at much higher rates than workers in other professions. If you or a loved one were injured while working at a construction site in California, it is essential to know your rights. You may be entitled to compensation by filing a workers’ compensation claim as well as through a third-party claim.

Workers’ Compensation for Construction Accidents

The Occupational Safety & Health Administration (OSHA) lists falling, being struck by objects, electrocution, and caught-between accidents as the top four causes of fatal construction site accidents. Traumatic events often lead to severe injuries on construction sites; however, repetitive stress injuries that develop over time are also commonly suffered by construction workers. Back and spine injuries are typically caused by repetitively lifting objects, working in awkward positions, or uneven weight distribution on tool belts. California workers’ compensation covers traumatic injuries in addition to repetitive motion injuries.

When people think about workers’ compensation injuries, they often imagine sudden injuries that occur in a fall or other traumatic accident. However, accident-related injuries are not the only types of injuries covered by California workers’ compensation. Individuals suffering from repetitive stress injuries or repetitive motion injuries may also be entitled to compensation. Office workers are often vulnerable to injuries caused by typing and other office work. However, it is sometimes difficult for injured office workers to receive the compensation they deserve.

Carpal Tunnel Syndrome and Other Repetitive Motion Injuries

The most common office-related repetitive stress injury is carpal tunnel syndrome. Typing on a computer keyboard, filing, and other office tasks require repetitive hand and wrist motions. This can put too much pressure on the median nerve and can cause painful symptoms including numbness, tingling, weakness, and pain. Medical conditions such as diabetes, rheumatoid arthritis, and thyroid disorders increase a worker’s chances of developing carpal tunnel syndrome. According to the Bureau of Labor Statistics, the median number of workdays missed due to carpal tunnel is 27. Cervical radiculopathy, ganglion cyst, tendonitis, De Quervain's Disease, and bursitis are other repetitive stress injuries that may be caused by office work.

Unlike in many other states, workers' compensation is mandatory for all employers in California. It does not matter if an employer has hundreds of employees or only one. It also does not matter if the injured employee was working full-time or part-time. Typically, self-employed individuals are not covered by the hiring entity’s workers’ compensation insurance. However, workers who have been misclassified as independent contractors may actually fall under the category of employee, which means that they would be entitled to coverage through workers’ compensation.

Individuals Who Are Not Covered by Workers Compensation in California

California has wider-reaching workers’ compensation coverage than many other states. However, there are still some individuals who are not covered by workers’ compensation, including:

Losing a relative in an unexpected work accident is a devastating experience to go through. If your spouse has recently passed away due to injuries he or she sustained on the job, you may still be figuring out what to do next. In the midst of your grief, you may also be trying to determine how you will make ends meet without your loved one’s financial support. In California, if a worker is injured in an on-the-job accident, the worker is typically entitled to financial compensation through workers’ compensation. If an employee is killed in a work accident, the worker’s dependents are usually entitled to compensation called death benefits. However, obtaining the compensation you need and deserve after losing a loved one in a work accident is often more complicated than many expect.

Workers’ Compensation Death Benefits in California

The compensation available can be for family members who were totally or partially financially dependent on the deceased worker. Some individuals are considered total dependents of the deceased worker. Minor children, disabled adult children, and surviving spouses with an annual income under $30,000 are automatically considered totally dependent on the worker. Stepchildren, spouses who make above the income threshold, grandchildren, parents, siblings, and other family members may qualify for death benefits. However, they will need to provide evidence that shows that they were partially or totally dependent on the deceased worker.